HIV Treatment: Everything You Need to Know

Maybe you’ve just learned you are living with HIV and have questions about starting the treatment process. Or maybe you’ve been living with HIV for years but haven’t really updated yourself as to the latest advances in treatment. Well, you’re in luck! If you need information about HIV treatment, you’ve come to the right page.

In the past four decades of addressing HIV in this country, a lot of scientific and social advances have occurred that shed light on all the aspects of how you can best treat yourself—in mind as well as body—if you are living with HIV.

Gone are the days of the oversimplified cliché, “HIV is not the death sentence it used to be.” While this is certainly true, living with HIV today embraces what it means not only to survive, but to thrive when you are living with HIV.

Here’s what you need to know about how to “treat” HIV as the virus it is, but also how to “treat” yourself as the whole person you are.

Is HIV Treatment All About HIV Medications?

The answer to this question is, “Yes and no.”

HIV is a virus, and scientists have made progress in terms of understanding how it is transmitted and what we can do to slow it down. In the late 1980s, toxic antiviral medications like AZT and D4T were the only options for people diagnosed with HIV.

Today, there are well over 30 individual medications and combination pills, many of which are full antiretroviral therapy (ART) regimens that can be taken daily. A person living with HIV right now can control the virus by taking one pill, once a day—very similarly to how people living with high blood pressure or diabetes may only need one pill, once a day to manage these conditions.

To understand how ART works to treat HIV, it’ll help to first understand what HIV tries to do when it’s inside a person’s body. Here’s a quick rundown of the process:

Viruses need a host to reproduce. HIV is unique in that it uses our own bodies’ immune system cells (T cells) to both reproduce and destroy the immune system.

To do this, HIV attaches to the T cell and inserts its genetic material into it.

Then a group of HIV proteins called “enzymes” helps it to change this genetic material.

The result is that HIV basically hijacks the T cell and uses it to make more copies of itself.

In other words, HIV breaks into a T cell like a thief might break into a factory, but with a twist: This thief takes over all the machinery in the factory and uses it to create more thieves, which then break into more factories, create even more thieves, and so on.

By taking ART, you slow down the virus—and can even freeze it in its tracks. That gives your immune system time to recover and get stronger, so you can get back to love, life, school, work, and whatever else your heart desires.

HIV meds work in a few different ways. Some prevent the virus from attaching to a T cell. Others block the proteins that help HIV make more copies of itself after it gets inside a T cell.

This is why you want to take a combination of medications—a treatment regimen—that stops HIV from making copies of itself at different steps along its lifecycle.

For instance, most pills that are initially prescribed to treat HIV, like Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) or Triumeq (abacavir/dolutegravir/lamivudine), have three different medications in them, and each medication works at a different point of the process where HIV tries to make more copies of itself. This way, if the virus figures out how to outmaneuver one of the medications in the pill, you still have two additional medications that can stop it.

This video on types of HIV treatments, featuring David Malebranche, M.D., is part of the #AskTheHIVDoc series by Greater Than AIDS, a public outreach program run by the Kaiser Family Foundation.

HIV medications are, first and foremost, about helping you maintain the healthiest you. We consider HIV treatment a “success” when the medications are able to keep the copies of the virus (your “viral load”) very low—ideally less than 20 copies of HIV per milliliter of blood, though less than 200 is also good.

When the viral load gets this low, this is what we call “undetectable.” We use that term because some viral load tests aren't able to accurately detect HIV in amounts below 200 copies per milliliter of blood, and most can't detect a viral load below 20. "Undetectable" means HIV is making virtually no copies of itself inside your body, and the medications are keeping your infection at bay.

Being undetectable also means that you have essentially zero chance of passing the virus on to your sexual partners, even when not using condoms. Knowing this, we now say “undetectable equals untransmittable,” or “U=U” meaning that when you take your medication consistently and correctly, not only does it benefit you, but it benefits your sexual partners as well.

In summary: HIV treatment is first and foremost about taking medications to control the virus. But that’s only part of the story: It can be just as important to take care of your mental health and to ensure you have support when you need it.

How Do Mental and Social Support Play a Role in HIV Treatment?

Your mental and emotional health are extremely important in the treatment of HIV.

Depression and high levels of stress can weaken the immune system. If you are living with HIV, this is particularly important because in addition to the daily stresses of life, you have a virus that your immune system is fighting, which can cause a lot of inflammation—the kind of inflammation you can’t see, since it’s happening inside your body. This inflammation can weaken your immune system over time—and if that happens alongside untreated stress or depression, it can put your physical health at risk.

This is why ignoring your mental health is not an option as part of your HIV treatment plan.

There are three important things you can do to ensure that mental health is a routine and consistent part of your treatment regimen:

Find someone you can confide in about your HIV status, so you don’t have to tackle it alone.

It’s a well-known fact that people living with HIV who have good social support are better able to take all their treatment doses (this is called adherence) and make it to their medical appointments, which leads to better health outcomes than for those who don’t have support.

It just makes sense: HIV can be scary and confusing, and it opens a person up to additional layers of social stigma and discrimination. Feeling down, anxious, or stressed can also lead a person to isolate themself, skip doses of their HIV medications, or avoid following up for routine visits with their medical team.

Moreover, neglecting mental health can result in a frame of mind where a person is more likely to embrace less-healthy coping behaviors to coat over pain and stress: using drugs, overeating, gambling, etc. Any of those can negatively impact how consistently a person takes their HIV meds or stays engaged with their medical treatment plan.

This is why addressing mental health is just as important as the medications themselves in an overall HIV treatment approach.

No one deserves to go through an HIV diagnosis alone, and finding support can be empowering. This isn’t a “coming out” moment, but rather an “inviting in” moment: You get to choose who you trust to bring into your space about your diagnosis, and they can help you manage things when you need the help.

Now, you might feel that there’s nobody in your life right now who you’d be comfortable sharing your diagnosis with. If that’s the case, understand that there’s still hope, even if there are no family or friends who you feel would have your back if you let them in.

In case you can’t find anyone in your immediate circle of friends, family, or loved ones, you can do the following:

Reach out to someone at your clinic or care provider who you feel you can trust.

Ask your care provider about speaking to a “peer navigator.”

Speak to a social worker or case manager about finding local community support.

Check out online resources available to you.

Whatever your situation is, know that you are not alone, and there is always someone to talk to—even if sometimes you need to take extra steps to find them.

Mental health is a changeable thing: We all have good days and not-so-good days. Make sure you are honest with yourself about how you are feeling, acknowledge how it’s affecting you, and identify someone to reach out to when you need help or a listening ear.

Remember: Your mental health has an impact on your physical health. Tending to your mental and emotional needs will help ensure that you stay on HIV medications and fight off the effects of the virus on your body.

We asked some of the most experienced, well-respected HIV physicians in the U.S.: Apart from taking HIV medications, what's the most important piece of advice you have for people living with HIV on staying healthy? Here's what they had to say.

How Does My Health Care Team Fit Into My Treatment?

Your health care team plays a huge role in your HIV treatment plan. They’re there to help you maintain your overall well-being. That includes checking your viral load, staying up to date on vaccinations, and tending to other parts of health care maintenance.

We’re not just talking about the person who’s prescribing your HIV meds. Your HIV treatment is about much more than just the relationship you have with your doctor, nurse practitioner, or physician’s assistant. This is a team approach, with you as the team leader.

You’re taking care of your body, and you’ve hired a group of experts and specialists to help you reach your health goals. This group will include not only your primary clinician, but many other types of care providers, including:

case managers

nurses

peer navigators

pharmacists

phlebotomists

social workers

Use everyone at your disposal! Don’t settle until you feel you have a team of care providers who are a good fit for you.

All forms of discrimination, implicit bias, and HIV stigma are alive and well in this country, and medical facilities that have expertise in HIV care and treatment are no exception. The good news is, it doesn’t have to be that way—but this is where it’s important to find your voice.

If you get a whiff of any health care professional or staff member treating you in a rude, disrespectful, or stigmatizing way? Speak up! Report them to the clinical manager or head of the facility. Express your discomfort directly with the person who made you feel that way. You’re the one in control, not them.

Remember: You have a choice. This is about your body, your health. Become engaged, informed, and passionate about your health any way you can. If your medical provider doesn’t show an appreciation for that, request to get another provider with whom you may feel more comfortable as a part of your team.

Having a caring and affirming relationship with your medical staff is not optional; it’s essential. When you go to get your checkups, you don’t want to be scared or bracing for a fight—you want to feel like you are stepping into a safe space where your worth will be affirmed. A place that isn’t all doom and gloom, but instead gives you hope and serves as a source of strength and inspiration.

In this video from Greater Than AIDS, David Malebranche, M.D., explains why it's important for people living with HIV to keep regularly seeing their health care provider.

Is It OK to Use Natural, Homeopathic, Alternative, or Complementary Treatments for HIV?

When we have these conversations about HIV treatment, it’s crucial to know that while prescription HIV medications (ART) are essential, they don’t have to be the only form of treatment you take into your body. You don’t have to choose between HIV medications and complementary treatments.

As we’ve established, HIV medications are the foundation of your treatment, but there are plenty of other things you can do to help your immune system keep the virus at bay. They include:

mental health care

massage

yoga

acupuncture

meditation

herbs and supplements

There have been small studies that demonstrate the benefit of yoga on immune system health among people living with HIV, but larger studies still need to be done. Regardless, physical interventions like yoga, massage, acupuncture, and meditation can have positive effects on your mood, spirit, pain, energy, and overall well-being. And that, as we’ve discussed, can lead to physical benefits as well.

There is also some evidence suggesting that certain herbs and other natural treatments may slow HIV during stages of its life cycle. They include products like:

Milk thistle

St. John’s wort

ginseng

echinacea

turmeric

green tea

marijuana

garlic

But the science is not conclusive regarding any benefits these products may have in fighting HIV specifically. If you experience positive effects on your health or sense of well-being from taking them, it may simply be because these supplements have sometimes been found to be helpful in promoting a person’s immune system function and overall health.

If you choose to perform any of the activities or take any of the non-medicinal therapies mentioned above, make sure you also do these two things:

Mention them to members of your medical team. Keep in mind that some complementary therapies can interact with traditional medications, including HIV drugs, in ways that might reduce their effectiveness or cause side effects. Be vocal about what you are using, so that you and your health care team both stay well informed.

Be open to discussing the pros and cons of these therapies. Be honest with your health care providers about the importance of these other aspects of HIV treatment in your life. Work in partnership with them to ensure the combination of treatments you’re taking is safe and effective.

Keep yourself informed. Many herbal and natural products, despite being labeled as something that can treat HIV, have not been extensively studied in humans. That means we still don’t fully understand how they can affect your body or your immune system, for good or for bad.

Be especially wary of anything that claims to “cure” HIV. As we’ll cover later in this article, there is no drug, supplement, or physical activity that can wipe out HIV in a person’s body.

Is There a Cure for HIV?

In the way we normally define what a cure is—a way to eradicate HIV in the body of every person who’s living with the virus—the answer is no, there is still no cure for HIV. But there’s more to this than a simple “no.”

In this video from Greater Than AIDS, David Malebranche, M.D., explains why we haven't yet been able to cure HIV.

HIV Has Been Cured—But Only in One Person

In 2006, a man named Timothy Ray Brown was living with HIV and leukemia—and he was out of cancer treatment options. He agreed to undergo a very specific, and very dangerous, type of stem-cell transplant: One that involved a donor who wasn’t just a good match for him, but who also happened to have an extremely rare genetic quirk that made them naturally resistant to HIV.

Nearly 15 years later, Brown is completely HIV-free, according to every measuring tool we have available.

He’s still the only person who has been confirmed cured of HIV. This is because the type of transplant Brown received is almost impossible to pull off successfully—and if it’s not successful, it can be deadly. This is why, even for Brown, it was a last-ditch effort, and he only did it because there were no other ways to treat his cancer.

Similar transplants have been done in a small number of additional people over the years, but it’s still too soon to tell whether these have truly cured HIV in those people. Even if they do, it won’t be possible to use this method to cure the millions of people living with HIV worldwide.

Throughout the world, there is a huge number of scientists, communities, and organizations working tirelessly to find other ways to cure HIV for everyone. This includes “sterilizing” cures, which can potentially eradicate HIV from the human body. They also include “functional” cures, which mean suppressing the virus to such a low level in the body that it will not reproduce or continue to destroy the immune system, even when someone is not on HIV medications.

Don’t Be Fooled by HIV Cure Scams

There are cycles of news stories, and plenty of Facebook posts, that talk about a magical HIV “cure” that somehow hasn’t yet made its way to the millions of people living with HIV throughout the world. Sometimes it’s a claim about a new breakthrough that has just become available or that scientists just discovered—and all you need to do is call a phone number or send an email to learn more.

There are also conspiracy theories that a cure for HIV exists, but that it is being withheld by pharmaceutical companies that want to ensure that people living with HIV continue taking medications and increasing company profits. None of these are even remotely true.

For example: For many years, a major cure myth involved a person known as “Dr. Sebi,” who claimed he had cures for HIV, herpes, and many other medical ailments. Some famous people even bought into it. This was all a lie.

While it is true that private pharmaceutical companies do exist to make profits, many of the researchers who work for those companies are in it because they genuinely want to find a cure for HIV. These researchers have already found cures for other viruses, like hepatitis C.

When you come across articles that make claims of having a “cure” to HIV while doing your research, examine them closely and pay attention to the claims they are making. There are a lot of opportunists out there who prey on the desperation of people struggling with chronic diagnoses like HIV, cancer, and others, in hopes for a quick fix or cure.

We May Not Have an HIV Cure—But We’ve Got Something Close

Fact is, there are tons of scientific studies to support how prescription HIV medications slow down progression of HIV and also make it impossible for people living with HIV to pass the virus on to others.

People taking modern HIV treatment now face the very real possibility that they will live just as long as a person who is not HIV positive. Think about utilizing these proven treatments to maximize your health while we all work towards a cure!

The Take-Home About HIV Treatment

Whether you are newly diagnosed with HIV, a long-term survivor, or anyone in between, it’s never too late to embrace the advancements in treatment knowledge that will help you live a long, productive, and pleasurable life—physically, emotionally, and sexually.

Here are some take-home points to carry with you as you journey forward:

Get on antiretroviral therapy (ART).

Take care of your mental health.

Alternative therapies can be helpful, but do your research.

Demand the medical care you deserve—you are worth it!

Tailor your treatment so it fits your life.

HIV treatment is a comprehensive plan, not just a daily pill. Talk about it with people you trust, find out what’s available to you, use the options you feel are best for you, and give yourself permission to live your best life.

“Natural Products as Anti-HIV Agents and Role in HIV-Associated Neurocognitive Disorders (HAND): A Brief Overview,” Front Microbiol. January 2016. ncbi.nlm.nih.gov/pubmed/26793166

David Malebranche, M.D., M.P.H.

David Malebranche, M.D., M.P.H., is a black same-gender-loving educator, author, activist, and internal medicine physician. He co-hosts the YouTube series 'Revolutionary Health' as part of The Counter Narrative Project and also appears on the #AskTheHIVDoc video series.